Provider Demographics
NPI:1689832982
Name:CHILDREN'S & FAMILY COUNSELING SERVICES, PC
Entity Type:Organization
Organization Name:CHILDREN'S & FAMILY COUNSELING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-644-1230
Mailing Address - Street 1:4716 BRYANSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3268
Mailing Address - Country:US
Mailing Address - Phone:704-644-1230
Mailing Address - Fax:704-675-5701
Practice Address - Street 1:4716 BRYANSTONE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3268
Practice Address - Country:US
Practice Address - Phone:704-644-1230
Practice Address - Fax:704-675-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003786Medicaid